health care workers safety in h1n! influenza

Dr.T.V.Rao MD 1

Health Care Workers Safety

InfluenzaDr.T.V.Rao MD

Dr.T.V.Rao MD 2

Circulating Influenza Strains and Pandemics in The 20th Century

1920 1940 1960 1980 2000

H1N1

H2N2

H3N2

1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”

20-40 million deaths 1-4 million deaths 1-4 million deaths

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What is Swine Flu?• Swine flu (also called swine influenza) is outbreaks in

pigs.

• People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.

• The 2009 swine flu outbreak (began in April) in humans is due to a new strain of influenza A virus subtype H1N1 that derives in part from human influenza, avian influenza, and two separate strains of swine influenza.

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CHALLENGES WE FACE• Recognition of disease• Not to forget chikungunya & dengue, other

viral infections• Difficulty in Confirmation of disease• Self protection• Protection of people around us• Notification• To know more ; Are we facing the pandemic?

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HOW DOES SWINE FLU SPREAD?

Coughing or sneezing of people with influenza

Touching something with flu

viruses to your mouth or nose

Spread of the swine

influenza A (H1N1) virus [the same as seasonal flu spreads]

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Viral Re-assortment

Reassortment in pigs

Reassortment in humans

Pandemic Influenza Virus

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PIG THE CREATOR

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EPIDEMIOLOGY• Incubation period- 1-7 days• Transmission PRIMARY CASE –direct contact with pigs SECONDARY CASES sneezing, coughing respiratory droplets

body fluids(diarroeal stool) contact surfaces

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Transmission

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Spread of Influenza Virus

• This virus is not transmitted from eating pork or pork products

• Contagiousness:1 day onset of symptoms 7 days Children are contagious for longer periods.. Majority of patients were previously healthy. Clinical course mild in PCR negative influenza.

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EARTH LIVING SPACE FOR ALL Including Influenza Virus

Epidemic: An increase in disease above what is normally expected Pandemic: A worldwide epidemic

A pandemic begins when: there is person-to-person sustained transmission on multiple continents

Proper Handling of Pig meat a Priority

• Influenza viruses do not affect the safety of pork, according to the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO). As with any raw meat, pork should always be properly handled and cooked to eliminate a range of food safety concerns.

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Signs and SymptomsHuman Influenza

Type of infection Upper and lower respiratory

Fever Yes

Headache Yes

Cough Yes

Respiratory symptoms Varies; sore throat to difficulty breathing

Gastrointestinal symptoms Uncommon, except children, elderly

Recovery 2-7 daysDr.T.V.Rao MD 13

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Swine flu – A Acute respiratory infection

• Swine flu is an infection caused by a virus. It's named for a virus that pigs can get. People do not normally get swine flu, but human infections can and do happen. The virus is contagious and can spread from human to human. Symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue.

Swine flu spreads through Respiratory route

• The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes.

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Swine flu can begin with• Fever

with Sudden symptoms of

• Aches• Chills• Tiredness

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May Preset with more severe Symptoms

• Fever (usually high) • Headache • Muscle aches • Chills • Extreme tiredness • Dry cough • Runny nose may also occur but is more common in

children than adults • Stomach symptoms, such as nausea, vomiting, and

diarrhea, may also occur but are more common in children than adults

• Donot self Diagnose Visit a Health Centre

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Collection of Specimens • Nasopharyngeal swab, nasal swab, throat

swab, combined oropharyngeal/ nasopharyngeal swab, or nasal aspirate

• Swabs with a synthetic tip (eg, polyester or Dacron) and an aluminum or plastic shaft should be used. Swabs with cotton tips and wooden shafts are not recommended.

• The collection vial in which the swab is placed should contain 1 to 3 mL of viral transport media.

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Collection and Transportation

• Respiratory specimen should be collected within 4 to 5 days of illness or at the earliest

• Specimens should be placed in viral transport media and placed on ice (4ºC) or refrigerated immediately for transportation to the laboratory

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Whom to test• Testing for pandemic H1N1 influenza A

should be considered in individuals with an acute febrile respiratory illness ( temperature of 100ºF or higher and recent onset of at least one of the following: rhinorrhea, nasal congestion, sore throat, or cough) or sepsis-like syndrome

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Priority and Recommendations in Testing

Priority for testing should be given to : Those who require hospitalization and Those who are at high risk for severe

complications No testing if illness is mild or the person resides

in an area with confirmed cases Recommended test for suspected cases is real-

time reverse transcriptase (RT)-PCR for influenza A, B, H1, and H3

Diagnosis• To diagnose swine influenza A

infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus

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Rapid Diagnosis

•RT PCR can make rapid Diagnosis

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• Frequent hand washing• Covering coughs and sneezes• Avoidance of crowded settings when possible• advising ill persons to stay home (except to seek medical care) and minimize contact with others in household• voluntary home quarantine of members of households with confirmed or probable swine influenza cases

Hand WashingMethod

• Wet hands with clean (not hot) water• Apply soap• Rub hands together for at least 20

seconds• Rinse with clean water• Dry with disposable towel or air dry• Use towel to turn off faucet

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Alcohol-based Hand Rubs

• Effective if hands not visibly soiled• More costly than soap & water

Method• Apply appropriate (3ml) amount to

palms• Rub hands together, covering all

surfaces until dry

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Isolation Precautions

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Care for common materials used by Swine flu patients

• Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.

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Antivirals- Oseltamivir• Treatment is 75 mg twice a day for 5 days.• Prophylaxis is 75 mg once a day for 7 days

after last exposure.• Prophylaxis:

– High risk exposure (household contacts)– Moderate risk (unprotected very close exposure to

sick animals; HCW with unprotected exposure to patients)

– Low risk exposure: no need for prophylaxis unless activation of exceptional measures.

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* household close contacts (of confirmed, probable, or suspected case) at high-risk for complications of influenza + chronic medical conditions + aged ≥ 65 years + aged ≤ 5 years + pregnant women

* school children or children in daycare at high-risk for complications of influenza (certain chronic medical conditions) who had close contact (face-to-face) with confirmed, probable, or suspected case

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*Any healthcare worker at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) working in area with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness

* Non-high risk travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection

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•Pre-exposure – Treat during exposure period and for 10 days after last known exposure to ill confirmed case of swine influenza A (H1N1) virus infection•Post-exposure – Treat for 10 days after last known exposure to ill confirmed case of swine influenza A (H1N1) virus infection

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Use of Mask by Patients and Health care Workers

• The use of surgical or procedure masks by infectious patients may help contain their respiratory secretions and limit exposure to others. Likewise, when a patient is not wearing a mask, as when in an isolation room, having health-care personnel mask for close contact with the patient may prevent nose and mouth contact with respiratory droplets

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Can the Mask Prevent the Spread of Flu ???

• However, no studies have definitively shown that mask use by either infectious patients or health-care personnel prevents influenza transmission

Prevention is best option• Covering your

nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

D

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Using N95 mask reduces the Risk

• You can cut your risk of contracting the flu or other respiratory viruses by as much as 80 percent by wearing a mask over your nose and mouth, according to a new study.

Emerging Infectious Diseases, the journal of the Centres for Disease Control and Prevention (CDC) .

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Mask can increase Personal Protection

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Why do we need vaccine

COST EFFECTIVETARGET AT RISKPEOPLE

VACCINE

WINTER SEASONTO COME(LOW HUMIDITY,TEMP)

RAPID GLOBALSPREAD

SEASONAL VACCINEPROTECTION?

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"flu shot”• The "flu shot" — an

inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

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Nasal Vaccination• The nasal-spray flu

vaccine —a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "live attenuated influenza vaccine" or FluMist®). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age who are not pregnant.

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How to Keep Away from Swine Flu?A,B,C,D of Prevention

A. Wash your hands with soap or hand cleaners.B. Avoid touching your eyes, nose or mouth. C. Drink plenty of fluids and eat nutritious food. D. Cover your nose and mouth with a tissue.E. Try to stay in good general health. F. Get plenty of sleep to be physically active.G. Manage your stress.H. Try not touch surfaces that may be

contaminated with the flu virus. I. Avoid close contact with people who are sick.J. Get treatment and/or prevention of the

infection with antiviral drugs.

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• Transport of deceased persons in a transport bag. • Hand hygiene should be performed after completing

transport. • For deceased persons with confirmed, probable, or

suspect novel influenza A (H1N1):o limit contact with the body in health care settings

to close family memberso Direct contact with the body is discouragedo Necessary contact may occur as long as hands are

washed immediately with soap and water.

Dealing with the Deceased

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Stop Spreading Virus Promote Prevention

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Your Hand Washing Practices are best contribution to Hospital Safety

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• The Programme Created by Dr.T.V.Rao MD as Public Health Message on Prevention and

Control of Swine Flu among the Health Care Workers• Email

• doctortvrao@gmail.com